Sexual orientation differences in teen pregnancy and oral contraceptive use in two U.S. national cohorts of different generations

BACKGROUND: Teen pregnancy is associated with adverse health and social outcomes. Sexual minority adolescents may be at higher risk for not using oral contraceptives (OCs) and becoming pregnant. PURPOSE: To examine sexual orientation group disparities in teen pregnancy (13-19 years) and OC use among adolescent females in two intergenerational cohorts. METHODS: The Nurses' Health Study II (NHSII) is a prospective cohort of women born between 1947-1964. The children of NHSII participants, born between 1982-1987, were enrolled in the Growing Up Today Study (GUTS), another prospective cohort study. Survey data on sexual orientation (defined by identity and sex of partners), teen pregnancy, and OC use were gathered from 91,003 NHSII women and 6,463 of their children in GUTS. Log-binomial models estimated the risk ratio (RR) for teen pregnancy and OC use in sexual minorities compared to heterosexuals, controlling for age, race, and geographic region. RESULTS: Overall, teen OC use was lower and teen pregnancy was higher in NHSII than GUTS. Significant differences by sexual orientation persisted across generations. In NHSII, bisexuals and lesbians were more likely to use OCs as teenagers compared to their heterosexual peers. The GUTS cohort showed a similar trend for bisexuals, but lesbians were less likely to use OCs compared to heterosexuals. All sexual minority groups in both cohorts were at increased risk for teen pregnancy, with RRs ranging from two-fold to as much as five-fold (RRs: 1.7 to 5.6, p-values<.0001). CONCLUSIONS: Sexual minorities are at increased risk for experiencing a teen pregnancy across generations.